Foreword

By David Stewart, Ph.D.,
Executive Director, National Association
of Parents and Professionals for Safe
Alternatives in Childbirth
(NAPSAC) International

This brief booklet may change your life. It could be the most important
few pages you have read yet in guiding you to choose the safest alternatives
in childbirth for you and your baby.

Most of American obstetric practice in hospitals is not based on science
but on myth. What obstetricians do may be the utmost in high-tech, but
it is not true science. What you don't know about modern medicine can hurt
you and your baby, perhaps permanently.

The authors of this excellent little publication have thoroughly researched
what they say here. You can trust what they have written. It is factually
and scientifically correct.

The choices you make in childbirth for your baby — home vs. hospital.
midwife vs. doctor, natural vs. medicated birth — will impact the rest
of your child's life, and yours, too. It can be for good or for ill. The
choice is yours.

Should You Have Your Baby at Home?

Today in the United States, at the end of the twentieth century, advances
in science and technology account for many positive changes in our quality
of life. Yet more and more women from all walks of life are choosing to
give birth the old-fashioned way — in their own homes. Why?

The fact is, in spite of all the good that has come from scientific
discoveries and experiments, medical science has not been able to improve
the human body and the way it was designed to work. Yet when our bodies
are not functioning the way they were created to function, we are more
fortunate than our ancestors in that modern medical science can sometimes
help.

So why are families having homebirths? Though each couple may have individual
reasons, most plan homebirths because they believe that most of the
time pregnancy and childbirth are normal functions of a healthy body
— not a potential life-and-death crisis that requires the supervision of
a surgeon.

Science has not been able to improve upon the human body
and the way it was designed to work.

In 20 other countries, more babies survive their first
months of life than in the U.S.

There are risks involved in childbearing. In a small percentage
of cases the skills of an obstetrician/gynecologist and high-tech equipment
like ultrasound and fetal monitors are necessary in order for the mother
or the baby to survive childbirth without long-term ill effects.

The neonatal mortality rate for the U.S. in 1989 was slightly more than
10 per 1,000 live births.[1] We
have the most highly sophisticated and expensive system of maternity care
in the world, yet in the same year twenty other countries — countries
with less technology than we have in our hospitals and laboratories — had
more babies survive their first months of life than our babies in the United
States.

What do they do in those 20 countries to have better outcomes?

With fewer high-tech hospitals and obstetricians available, many of
those countries — like Holland, Sweden and Denmark — use midwives as the
primary care-givers for healthy women during their pregnancies and births.[2]

The World HealthOrganization urges the U.S. to return toa midwife-based system ofmaternity care.

Understanding the potential danger in the overuse of childbirth technology,
the World Health Organization has repeatedly implored the U.S. medical
authorities to return to a midwife-based system of maternity care as one
way to help reduce our scandalously high mortality rates.[3]

Midwives, in fact, still attend most of the births around the globe.
Physicians, in spite of their advanced training and surgical specialties,
have never been proven to be better childbirth attendants than midwives.
And no research has been done that proves hospitals to be the safest places
in which to give birth.

In fact, study after study has demonstrated that for the majority of
child-bearing women in the U.S., the homebirth/midwifery model should be
the standard for maternity care. In the pages ahead, you'll see why.

Studies Indicate That Homebirths Are Safe

Myth #1 — Hospital births are statistically safer than homebirths.

Safety in childbirth is measured by how many mothers and babies die
and how many survive childbirth in less than perfect health.

Studies done comparing hospital and out-of-hospital births indicate
fewer deaths, injuries and infections for homebirths supervised by a trained
attendant than for hospital births. No such studies indicate that hospitals
have better outcomes than homebirths.

Respiratory distress among newborns was 17 times higher in the hospital
than in the home.

The U.S. has the highest obstetrical intervention rates as well as
a serious problem with malpractice suits.

While maternal death rates have vastly improved since the turn of the
century, factors like proper nutrition and cleanliness have played a big
part in the change.

Overall neonatal death rates have also improved since the 30s, but homebirths
appeared to be safer even then. In 1939, Baylor Hospital Charity Service
in Dallas, Texas, published a study that revealed a perinatal mortality
rate of 26.6 per 1,000 live births in homes compared to a hospital birth
mortality rate of 50.4 per 1,000.[1]

Since the 1970s, research done in northern California, Arizona, England
and Tennessee all point to the relative safety of homebirth.[2]
The only matched population
study, comparing 1,046 homebirths with 1,046 hospital births, was published
in 1977 by Dr. Lewis Mehl, a family physician and medical statistician.[3]

While neonatal and perinatal death rates were statistically the same
in Mehl's report, morbidity was higher in the hospital group: 3.7 times
as many babies born in the hospital required resuscitation. Infection rates
of newborns were four times higher in the hospital, and the incidence of
respiratory distress among newborns was 17 times higher in the hospital
than in the home.

A six-year study done by the Texas Department of Health for the years
1983-1989 revealed that the infant mortality rate for non-nurse midwives
attending homebirths was 1.9 per 1,000 compared with the doctors' rate
of 5.7 per 1,000.[4] Certified
nurse midwives' mortality rate was 1 per 1,000 and "other" attendants accounted
for 10.2 deaths per 1,000 live births.[5]

A study of 3,257 out-of-hospital births attended by Arizona licensed
midwives between 1978-85 shows a perinatal mortality rate of 2.2 per 1,000
and a neonatal mortality rate of 1.1 per 1,000 live births.

In testimony before the U.S. Commission to Prevent Infant Mortality,
Marsden Wagner MD, European Director of the World Health Organization,
suggested the need in the U.S. for a "strong independent midwifery profession
as a counterbalance to the obstetrical profession in preventing excessive
interventions in the normal birth process."[6]

Wagner states that in Europe midwives far outnumber physicians: "In
no European country do obstetricians provide the primary health care for
most women with normal pregnancy and birth." He states that the U.S. has
the highest obstetrical intervention rates as well as a serious problem
with malpractice suits and concludes that a strong, independent midwifery
service in the U.S. would be a most important counterbalance to the present
situation.

Midwives Are Trained Professionals

Myth #2 — You can get more professional attention in a hospital
than you could get at home.

In the hospital, obstetricians do not routinely sit at the bedsides
of their laboring patients but rely on machinery and others for information
— then appear at the last minute in the delivery room. Most physicians
do not build a relationship of supportive rapport with each patient or
offer much encouragement to give birth naturally.

Labor and delivery room nurses by and large enjoy giving support to
women during childbirth. Hospital life, however, involves a great deal
of paperwork, personnel changes by the clock and wild fluctuations in how
many women each nurse must be responsible for. And nurses have no authority
to stop an impatient doctor from trying to "speed up" a slow-but-steady,
normal labor.

Over the last few decades, women have protested against the cold and
clinical atmosphere of birthing wards, and many hospitals have bent under
popular pressure to make their sterile environments more home-like.[1]
Most allow women's partners into labor and delivery rooms, and some even
accept the presence of a professional labor coach.

But for many women, the natural act of giving birth does not belong
in a clinical environment when all is well.

Planned homebirths with a trainedattendant present havegood outcomes.

While statistics indicate that unplanned or unattended homebirths have
worse outcomes than hospital births, planned homebirths with a trained
attendant present have good outcomes.[2]

There are a variety of trained and experienced homebirth practitioners
from which to choose — physicians, certified nurse midwives and direct-entry,
or non-nurse midwives. A small number of doctors, some of whom are members
of the American College of Home Obstetrics, maintain homebirth and/or clinic
practices. Several birth centers in the U.S. are physician-owned and operated.

Certified nurse midwives are registered nurses who have continued their
education in the specialty of obstetrics. Most CNMs work only with physician
backup in a hospital environment, but a few have homebirth practices.

Midwifery is basically a system of wellness care given by professional
midwives to women and infants during the childbearing year, and in many
other countries midwives are the primary care givers in maternity systems
with better neonatal mortality rates than ours. Midwives are trained to
watch for deviations from health throughout the pregnancy and labor and
refer their clients to a physician if necessary.

Midwives are the primary care-givers in countries with better neonatal
mortality rates than ours.

Prenatal visits with a midwife are usually relaxed, friendly and
can last from 30 minutes to an hour.

The number of direct-entry midwives has increased in the last twenty
years due to more demand for their services. Most non-nurse midwives have
completed a course of study and then furthered their education by apprenticing
with a more experienced midwife. These midwives practice legally in only
12 states, some of which require them to be licensed. Where midwifery is
illegal, the states have declared these time-honored professionals to be
"practicing medicine without a license."

Prenatal visits to an obstetrician's office or public health department
usually involve long waiting periods before seeing a doctor or nurse for
a very brief checkup. By contrast, each prenatal visit with a midwife is
usually relaxed, friendly and can last from 30 minutes to an hour. Midwives
traditionally use this time for teaching the benefits of good nutrition,
exercise, hazards to avoid and how to prepare for a natural birth.

Though the educational background of midwives varies widely, many collect
laboratory specimens, monitor the baby's heart rate for signs of fetal
distress during labor, carry oxygen equipment and are trained in cardiopulmonary
resuscitation.

A Good Birth, A Safe Birth, 1990, Korte &
Scaer, p. 8-21.

Ibid, p. 64-68.

Technology Can Complicate a Normal Birth

Myth #3 — The more modern technology you have on hand, the easier
the birth will be.

In a sincere effort to catch complications early and produce healthier
babies, medical science has changed the atmosphere surrounding birth from
one of a circle of loving support around laboring women to one of space
age technology in a laboratory setting.

Though technology can save lives in a crisis, the routine use of technology
can interfere with the normal birth process.

Each intervention in a normal labor has its own set of risks.

The U.S. has the highest obstetrical intervention rates as well as
a serious problem with malpractice suits.

It is common in hospitals to use intravenous fluids and electronic fetal
monitors to ensure that the mother stays well hydrated and that each contraction
and beat of the baby's heart is recorded. However, many women dislike being
confined to a bed with needles in their arms and belts around their abdomens.

Women who are allowed to move about freely during labor complain less
of back pain, and many childbirth authorities feel the motion of walking
and changing positions can enhance the effectiveness of the contractions.

Some hospitals still require women to birth lying flat on their backs
with their legs held high in stirrups. Because the position defies gravity
and makes pushing less effective metal forceps are sometimes used to pull
the baby out of the vagina. Research shows that forceps are rarely used
when women are allowed to assume a position of comfort during the bearing
down stage.

Obstetricians frequently rupture the bag of waters surrounding the baby
in order to speed up the birthing process. This procedure automatically
places a time limit on the labor, as the likelihood of a uterine infection
increases with each passing hour in the hospital after the water is broken.

Once the protective cushion of water surrounding the baby's head is
eliminated, the belt monitoring the baby's heartbeat may be exchanged for
a scalp electrode — a tiny probe that is screwed into the baby's scalp
to continue monitoring the heart rate and to collect information about
the baby's blood.

Each of these interventions in a normal labor has its own set of risks,
and none of the above procedures has ever been proven to be more advantageous
in eliminating complications or to produce healthier babies.

A recent study published in a medical journal states that the routine
use of electronic fetal monitors, compared to the old-fashioned method
of listening to the baby's heartbeat after contractions with a fetoscope,
may actually cause more problems than it prevents.[1]
In eight randomized clinical trials, perinatal mortality was not reduced
with electronic fetal monitoring. And perhaps because electronic monitoring
can lead to unnecessary cesareans, birth outcomes were mostly superior
in the groups monitored by fetoscope.[2]

Today at least 25 percent of all birthing mothers are delivered surgically.
This compares to an average c-section rate of about 10 percent in other
countries with better mortality rates.[3]
These numbers indicate that we are not getting better outcomes with more
c-sections.

Several decades ago, in an effort to lessen the pain of childbirth,
physicians routinely gave laboring women pain-killing and anesthetic drugs.
Over the years the use of most of these medications has subsided somewhat
after studies revealed that drugs given to the mother had adverse effects
on the baby, including asphyxia, hypoxia and even brain and central nervous
system damage.[4]

Drugs are still available to laboring women in the hospital, though
no drug given in childbirth has been proven to be safe for the baby.[5]

Women who have taken drugs in labor report decreased maternal feelings
towards their babies and an increase in the duration and severity of postpartum
depression.[6]

The artificial hormone pitocin, a drug given to intensify labor and
to contract the uterus after childbirth also has potential side effects,
including rare cases of uterine rupture and a slight increase in jaundice
in the newborn.[7]

Interrupting the natural process of birth with technological wizardry
can cause more harm than good.

New England Journal of Medicine, March 1, 1990.

The Cutting Edge, Feb. 1990, p. 4, P.O. Box 1568,
Clayton, GA 30525.

Birth Without Surgery, Carl Jones, 1987, p. xii.

The Five Standards of Safe Childbirth, 1981,
Stewart, p. 185.

Ibid, p. 175

A Good Birth, A Safe Birth, 1990, Korte &
Scaer, p. 18, 201-209.

The Five Standards of Safe Childbirth, 1981,
Stewart, p. 300.

Normal Household Germs Do Not Affect Mother or Baby

Myth #4 — A hospital is a more sanitary place to have a baby
than at home.

Childbed fever killed thousands of women in the 19th century — about
the time physicians, who also cared for the ill and dying, began to attend
births in clinics. As hospitals became the places to go for birth and death,
infections became a plague upon childbearing women and other hospital patients.

About 100 years ago, in Austria, a doctor named Ignaz Semmelweis attempted
to lower the number of maternal deaths from infections — as high as 40
percent of those delivering at the Vienna maternity hospital.[1]
Semmelweis discovered that simply by washing their hands between performing
autopsies and attending births, the rate of infections caused by doctors
dropped dramatically. Semmelweis was ridiculed by his colleagues, and it
wasn't until five years after his death that his findings began to gain
acceptance. With the advent of aseptic technique in the late 1800s and
the development of antibiotics in the 1940s, gradual improvement was seen.
[Ed. — As antibiotic-resistant bacteria have evolved so that they are unaffected
by antibiotics, it can be expected that this trend will be reversed, and
we can expect to see an increase in deaths from hospital-acquired
infections.]

In the 1930s, studies in New York City and Memphis, Tennessee, show
that fewer women died from infections and hemorrhage during homebirths
than died from the same complications in the hospital.[2]

Strict and expensive infection control procedures have still not
eliminated hospital-caused infections.

Today, strict and expensive infection control procedures have still
not eliminated nosocomial, or hospital-caused infections from common and
dangerous organisms, like resistant strains of staphylococcus.

According to a report in the Wall Street Journal, the nation's
hospital-regulating agency, The Joint Commission on Accreditation of Health
Care Organizations, is failing to enforce infection control standards —
compromising the health of hospital patients: "The Joint Commission allows
dangers to health and safety to go uncorrected for weeks, months and even
years. Sloppy, irresponsible hospitals have little to fear from the Commission:
punishment in recent years has been nearly nonexistent."[3]

Each family becomes accustomed to its own household germs and develops
a resistance to them. Since fewer strangers are likely to be present at
a homebirth than at a hospital birth, the chances of acquiring foreign
germs are less likely in a homebirth situation.

Every effort is made to provide a clean environment at homebirths. Midwives
and homebirth doctors wear sterile gloves and use sterilized instruments
for cutting the umbilical cord.

Homebirth research studies indicate much lower rates of infection in
the mother and the baby than is likely in the hospital. In a 10-year study
(1970-1980) of 1,200 births at the
Farm in Summertown, Tennessee, 39 mothers suffered postpartum infections,
and only one baby developed septicemia.[4]

Calling the hospital nursery a cradle of germs, Dr. Marsden Wagner,
European Director of the World Health Organization, warned doctors at an
international medical conference in Jerusalem in the spring of 1989 that
hospital births endanger mothers and babies primarily because of impersonal
procedures and overuse of technology and drugs.[5]

The Birth Gazette, Fall, 1987, review of The
Cry and The Covenant, p. 32-33.

The Five Standards of Safe Childbearing, 1981,
Stewart, p. 240-241.

The Wall Street Journal, Oct. 12, 1988.

The Five Standards of Safe Childbearing, 1981,
Stewart, p. 127.

Mothering, Oct/Nov/Dec, 1989.

"There's No Place Like Home" For Childbirth

Myth #5 — A hospital is the most comfortable place to have a
baby.

The idea of being comfortable during childbirth may strike many mothers
who have delivered in the hospital as impossible. They remember being confined
to a hospital bed, denied food and water, separated from their other children
and supportive family members and friends, enduring frequent internal examinations
and vital sign checks, being transfered from one room to another on a stretcher
at the peak of labor's intensity and having their legs strapped into stirrups.

Birthing rooms and their homey furnishings are an effort to eliminate
some of the stress and discomfort that comes from being in the strange
surroundings of the hospital.

Studies show that labor can be compromised by an unfamiliar environment.
Discomfort and fear can actually increase the pain experienced in childbirth,
while relaxation can diminish maternal stress, improve oxygen flow to the
baby and facilitate labor.

In her own home a laboring woman has "the home court advantage." She
can move about freely, wear what clothing she chooses, sip on energizing
juices, continue caring for other children as she is able, relax in a warm
tub of water, have her feet rubbed by loving friends and try different
birthing positions. Normal labor is a healthy stress for the baby, clearing
the lungs of fluid and preparing it to take its first breaths.

After the birth, the baby is never taken from its mother's side. The
entire family can climb into a clean bed for a much needed cuddle and nap.
The emotional bonding that takes place in the moments after birth between
mother and child and between the baby and the entire family promotes well
being, encourages breastfeeding and speeds recovery of the mother.

Qualified Homebirth Attendants Are Available

Myth #6 — It's impossible to find any qualified person to assist
you in having a baby at home.

While discussion over the pros and cons of homebirths and who should
attend them continues in medical circles and around supper tables, thousands
of healthy babies are being born in their own homes each year.

Homebirth is not for every woman. It takes a high degree of commitment
to health and learning and a high level of responsibility to go against
the majority who believe hospital births are better.

As you consider where to give birth, read the books listed in the Resource
Guide. Talk to women who have given birth at home, in birthing centers,
in birthing rooms and in hospital delivery rooms. Discuss your concerns
with your physician and your midwife.

Interview several alternative birth practitioners in your area. Assess
the level of skill, integrity, knowledge and philosophy of each to discover
if they are compatible with your expectations. Whereas obstetricians deliver
the great majority of babies in hospitals, some are operating alternative
birthing centers. Family practitioners who attend births can still be found,
but their ranks are decreasing because of the soaring expense of malpractice
insurance.

Certified nurse midwives are located in many metropolitan areas, and
in some hospitals offer primary maternity care in a clinic and birthing
room setting. Well-educated and trained direct-entry midwives are specialists
in normal childbirth. Some operate birth centers, and many have homebirth
practices all across the country.

In 1989 the average family in the U.S. paid about $4,334 for an uncomplicated
hospital birth, according to a Health Insurance of American survey of 173
community hospitals, 70 childbirth centers and 153 licensed midwives.[1]

In 1989 the average family in the U.S.paid about $4,334 for anuncomplicated hospital birth.

Breakdown of costs for a hospital birth include an average physician's
fee of $1,492 ($2,053 for a cesarean), and hospital costs (not including
other fees like the services of an anesthesiologist) of about $2,842.

In 20 other countries, more babies survive their first months of
life than in the U.S.

In 1989 the average fee charged by a midwife was $994.

The average fee charged by a midwife was $994, a price that usually
includes prenatal care, childbirth classes and supplies, while a physician's
fee does not.

Which setting and type of birth attendant is right for you? In some
states, your choices are limited based on laws that restrict the practice
of midwives. Friends of Homebirth was founded in 1989 with the goal of
working to ensure your right to choose homebirth with a trained attendant.
Homebirth is a reasonable choice for many families, and restrictive legislation
must give way to the Constitutional right of responsible parental choice.